Beyond opioids: Common combinations of legal drugs detected among drug-related deaths in Los Angeles County, 2000-2009

Background Much of the research into the recent increases in prescription drug abuse has focused on the role of opioids. However, drug-related mortality may be impacted be the use of multiple drugs simultaneously. Examining which combinations of drugs are frequently detected in drug-related deaths can help guide prevention and treatment efforts.

Methods Data was obtained for all drug-related deaths in Los Angeles County between 2000 and 2009. Drug-related deaths without toxicology information and those only testing positive for illegal drugs were excluded. Deaths testing positive for 3 or more categories of legal drugs (opioids, sedatives, stimulants, anti-depressants, etc) were classified as multi-category drug deaths. Age, gender, race/ethnicity, alcohol use, and intent of death were examined.

Results Of the 8,265 drug deaths examined, 5,847 (71%) tested positive for at least one legal drug. Of these deaths, 2,067 (35%) were multi-category deaths, and 75% of these deaths tested positive for legal opioids. The majority of multi-category deaths were White (74%), female (54%), and 35-54 years old (63%). Opioids, sedatives, and antidepressants were the drug classes most frequently found in combination. In deaths without opioids, the most common combination was antidepressants, antipsychotics, and sedatives. Deaths testing positive for legal opioids were more likely to be accidental (79%) than those without legal opioid use (53%). Conclusions The use of multiple different types of legal drugs is quite common among drug-related deaths in Los Angeles County. Physicians and pharmacists should be aware of the combinations of drugs most commonly associated with death.